Homan Sign
Table of Contents
What is the Homan sign?
The Homan sign is a clinical finding of discomfort behind the knee when the foot is forcibly dorsiflexed. This sign was first published in 1994 by American physician John Homans and has usually been conducted as part of the physical examination in persons with suspected lower extremity deep vein thrombosis (DVT). The mechanism underlying the Homan sign is assumed to be that knee flexion and forceful dorsiflexion of the ankle cause traction on the posterior tibial vein, resulting in discomfort behind the knee.
When searching for the Homan sign, the individual’s knee should be flexed. The examiner will next forcefully and suddenly dorsiflex the individual’s ankle and look for discomfort behind the knee, indicating a positive Homan sign. An accurate result may not be achieved if the dorsiflexion is not strong enough.
Purpose
The Homan’s sign test, also known as the dorsiflexon sign test, is a physical exam used to identify Deep Vein Thrombosis (DVT). A positive Homan’s sign may provide a quick warning of DVT in the context of other clinical symptoms. Clinical examination cannot be relied on to evaluate the need for additional testing (such as the D-dimer test, ultrasonography, multidetector helical computed axial tomography (CT), and pulmonary angiography) on its own.
Although clinical examination cannot be used to manage patients, it can be useful in evaluating whether further testing (such as the D-dimer test, ultrasonography, multidetector helical computed axial tomography (CT), and pulmonary angiography) is required.
Related History
According to John Homans’ 1941 definition, when the foot is pushed to the dorsiflex, it generates soreness behind the knee. Homans redefined the Homans sign in 1944 after numerous reports of false-positive Homans’ signs, saying that “discomfort need to have no part in the reaction” including that greater resistance, involuntary knee flexion, or calf discomfort in response to forceful dorsiflexion should be regarded favorable reactions.
How Do You Do The Homan’s Sign?
The Homans Sign test is conducted with the patient in a supine position. The examiner elevates the affected leg and extends the patient’s knee quickly while dorsiflexing the patient’s foot. While repeating this maneuver again with the patient’s knee bent, the examiner palpates the calf.
What exactly does a positive Homan sign indicate?
For many years, a positive Homan sign was assumed to represent a clinical indicator of lower extremity deep vein thrombosis; however, research reveals that not all people with DVT had a positive Homan sign at examination. As a result, the Homan sign is regarded as insensitive and nonspecific for DVT.
Intervertebral disc herniation, a burst Baker cyst, neurogenic claudication, calf muscular spasms, and lower leg cellulitis are among disorders that might cause a positive Homan sign. Individuals with a short Achilles tendon who normally wear high heels may have a positive Homan sign when they begin wearing flat shoes.
Because the Homan sign and clinical examination are unreliable in identifying DVT, further diagnostic tests are usually undertaken if DVT is suspected. Current recommendations favor clinical prediction scores (e.g., Wells score) and non-invasive procedures such as compression ultrasound with a Doppler and a D-dimer blood test for detecting DVT. If the diagnosis is ambiguous, more invasive venography, in which a dye is injected into the veins, might be done. To identify obstructions, an X-ray is performed.
Evidence
Passive, rapid, and forceful ankle dorsiflexion with limited knee flexion causes mechanical tension on the posterior tibial vein. This traction stimulates the pain-sensitive tissues in the lower leg.
Disorders with a positive Homan’s sign include intervertebral disc herniation, burst Baker’s cyst, neurogenic claudication, gastrocnemius spasm, and cellulitis.
Accuracy
Because of its limited sensitivity and specificity for diagnosing DVT, Homan’s sign can be useful when combined with more precise diagnostic procedures like as venography and ultrasonography.
Sensitivity/Specificity
Because a positive sign does not always indicate DVT and a negative sign does not always rule it out, it is thought to have a sensitivity of 10-54% and a specificity of 39-89% and is hence not seen to have any diagnostic importance.
However, it is frequently used in clinical practice, most likely because of its historical usage as well as the ease with which it may acquire information prior to the introduction of more accurate diagnostic methods (such as D-dimer titration or Doppler ultrasonography). The elevated D-dimer in the elderly population has minimal predictive value for deep vein thrombosis. General DVT signs and symptoms are only useful for assessing the probability of a DVT; they are insufficiently sensitive or specific to make a diagnosis.
Precaution
This test is potentially dangerous since surgeons utilize forceful foot dorsiflexion to remove clots from veins.
How Can You Avoid Common Mistakes?
Examiners frequently make the mistake of not dorsiflexing the patient’s foot sufficiently to obtain an accurate reading. The patient’s knee must be completely extended as well.
Limitation
Here are some of the limitations of the Homan’s sign test: Because it is not extremely sensitive for DVT, it may be negative in a significant proportion of DVT patients. Because it is not very specific for DVT, it may be positive in a large proportion of persons who do not have DVT.
It is less accurate in those who have certain conditions, such as obesity, calf muscle spasms, or who have recently had surgery. More precise diagnosis In addition to the Homans sign,
DVT testing includes: Contrast venography, Doppler and B-mode ultrasonography, Venous duplex imaging, and Impedance plethysmography Importance to Physiotherapists
While a patient is bedridden or unconscious, the Homan’s sign test may be a simple and quick approach to determine whether they are having a DVT and, if so, to continue with caution while performing certain lower-limb motions.
FAQ
Abstract. Homans’ sign is frequently used to diagnose deep venous thrombosis of the leg. A positive Homans’ sign (calf discomfort with dorsiflexion of the foot) may indicate the existence of thrombosis.
Homans’ sign is frequently used to diagnose deep venous thrombosis of the leg. A positive Homans’ sign (calf discomfort with dorsiflexion of the foot) may indicate the existence of thrombosis.
Homans sign: Pain in the calf muscles during forceful dorsiflexion of the foot with the knee straight has long been recognized as a marker of DVT. Homans sign, on the other hand, is neither sensitive nor specific; it is present in fewer than one-third of patients with confirmed DVT and more than 50% of patients without DVT.
The Homan’s sign test, commonly known as the dorsiflexon sign test, is a physical examination method used to detect Deep Vein Thrombosis (DVT).
Some clinicians regard Homans’ sign (sometimes spelled Homans sign or dubbed dorsiflexion sign) to be a marker of deep vein thrombosis (DVT). John Homans characterized it in 1941 as pain behind the knee caused by forceful dorsiflexion of the foot.
The Homan sign is no longer advised since it is unspecific.
Reference
- Homan’s Sign Test. (n.d.). Physiopedia. https://www.physio-pedia.com/Homan%27s_Sign_Test
- Osmosis – Homan Sign: What Is It, Uses, and More. (n.d.). Osmosis. https://www.osmosis.org/answers/homan-sign
- [Physical examination–the significance of Homan’s sign]. (1999, September 11). PubMed. https://pubmed.ncbi.nlm.nih.gov/10526599/
- Pettker, C. M., & Lockwood, C. J. (2017, January 1). Thromboembolic Disorders in Pregnancy. Elsevier eBooks. https://doi.org/10.1016/b978-0-323-32108-2.00045-7
- O. (2023, September 1). Homans Sign Test 2023. OrthoFixar. https://orthofixar.com/special-test/homans-sign/
- What are positive homan’s signs? – Siragusa Vein Laser. (2023, March 7). Siragusa Vein Laser – Nashville’s Vein Treatment Choice. https://nashvilleveincenter.com/what-are-positive-homans-sign/
- Homans sign. (2022, May 24). In Wikipedia. https://en.wikipedia.org/wiki/Homans_sign
